The Direct Medical Cost of Regular Monitoring of Patients with HBeAg-Negative Chronic Hepatitis B Virus Infection

Abstract

Objectives: Patients with hepatitis B e antigen-negative chronic infection (inactive carriers) account for most of the people living with hepatitis B virus (HBV). This study investigated the direct medical cost of monitoring patients within this group. Materials and Methods: A total of 293 outpatients receiving regular monitoring in a large university hospital were included in the study. Direct medical costs included laboratory tests, imaging, liver biopsies and co-payments. Linear mixed effect models were applied to investigate the effect of follow-up time on the annual cost of monitoring. We made quarterly, semi-annual and annual monitoring cost trajectories in accordance with international guideline recommendations. Results: The average annual direct medical cost per patient was 160 USD and the average laboratory visit cost per patient was 68.5 USD. HBV DNA testing contributed to a majority percentage of the total cost (59.6%). As follow-up time increased, the total annual cost (β=-2.07) and annual cost for DNA testing (β=-1.03) decreased. The cost trajectory of the first two years of monitoring remained above the semi-annual follow-up strategy. After three years, the cost trajectory of monitoring, while reducing slightly, remained between the semi-annual and annual follow-up strategy trend lines. Conclusion: Due to high-patient numbers, the total cost of monitoring presents a large economic burden. Taking into consideration the generally benign nature of the disease; the length of intervals between outpatient hospital visits could be reviewed and alternative strategies implemented with the aim of reducing expenditure.